Laparoscopic Uterine Artery Ligation Research Articles

Management of Hemorrhage during Dilation and Evacuation by Mid-Procedure Laparoscopic Uterine Artery Ligation

<h3>Study Objective</h3> To present a video demonstrating a multidisciplinary technique for managing hemorrhage during a dilation and evacuation (D&E) via intraoperative consult to minimally invasive gynecologic surgery (MIGS) and laparoscopic uterine artery ligation <h3>Design</h3> Case report. <h3>Setting</h3> Operating room at tertiary care center. <h3>Patients or Participants</h3> 37-year-old gravida 5 para 4 at 22 weeks gestation. <h3>Interventions</h3> A video demonstration of a laparoscopic, bilateral uterine artery ligation with pregnancy in situ to control mid-procedure hemorrhage. After initiating the D&E procedure, brisk bleeding was encountering with an estimated blood loss of 1600 mL within minutes. Options for controlling the hemorrhage were limited, as uterotonics or balloon tamponade were not possible with the pregnancy still in situ, and interventional radiology was not available for uterine artery embolization. An urgent, intraoperative consultation to MIGS was placed. A diagnostic laparoscopy was performed to evaluate for placenta accreta, uterine perforation, or other injury. No hemoperitoneum or defect was noted, however given ongoing heavy vaginal bleeding and potential need for a hysterectomy, the decision was made to proceed with uterine artery ligation prior to completion of the D&E procedure. Starting on the left side, the round ligament was incised, and the retroperitoneum was entered. The perirectal space was developed using the horizontal push-spread technique The uterine artery was skeletonized and ligated at its origin with a vascular clip. This was repeated on the contralateral side. Excellent hemostasis was noted, and the D&E was completed under laparoscopic guidance. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Mid-procedure laparoscopic uterine artery ligation is a feasible option for controlling hemorrhage during second trimester dilation and evacuation when more traditional methods are not feasible or unavailable. A multidisciplinary, subspecialty approach to management of gynecologic complications can help optimize safe gynecologic procedures.

Cesarean scar pregnancy - a retrospective analysis of cases in the years 2012-2021.

With the increasing number of caesarean sections, the number of cesarean scar pregnancies (CSP) is also increasing. This is a relatively new entity of an ectopic pregnancy, which is risky mainly because of its possible association with placenta accreta spectrum. CSP is thought to represent about 6% of the total number of ectopic pregnancies in all women who have a history of at least one caesarean section. The estimated incidence of CSP is about 1/1,688 of all pregnancies and about 1/2,000 of all caesarean sections. Retrospective analysis of individual cases of cesarean scar pregnancies managed in our health care facility in the years 2012-2021. In total, we managed 16 cases of pregnancy in the caesarean scar in 15 women. In one woman, we recorded CSP twice. The mean age of the women was 36.6 years (27-41). The mean number of caesarean sections was 1.6 (1-3) and gestational week was 7 (4-10). The average time since the caesarean section was 3.6 years (2-11). The management was methotrexate administration once, hysteroscopic resection once and 11times primarily vacuum aspiration only, when in two cases we had to attach laparoscopic uterine artery ligation due to postoperative bleeding. We performed primary ligature of uterine arteries twice before performing vacuum aspiration. In pregnancies above 10 weeks of gestation, we observed more bleeding complications requiring surgical management. Bleeding complications were also related to the presence of fetal cardiac action. Early correct dia-gnosis is essential in the management of CSP. Pregnancies up to the 10th week of gestation are managed by simple vacuum aspirations under ultrasound guidance. If the pregnancy is over the 10th week of gestation and especially with cardiac activity, we add laparoscopic uterine artery ligation before vacuum aspiration. All patients are subsequently advised to undergo laparoscopic resuturing of the lower uterine segment.

2953 Temporary Uterine Artery Ligation During Laparoscopic Myomectomy - Different Surgical Approaches

Video Objective Laparoscopic Uterine Artery Ligation may be performed during myomectomy in order to reduce the amount of blood loss during surgery. Setting Step-by-step video demonstration of three different techniques. Interventions Main steps of uterine artery ligation are described in detail as well as different laparoscopic variants to this procedure. Anterior Approach The impression of the uterine vessels can usually be seen anterior and laterally to the uterine cervix. After the identification of the path of the uterine arteries, the peritoneum of the anterior cul-de-sac is opened over the vessels and the uterine artery is carefully dissected next to the lateral border of the uterine cervix. This dissection must be extremely cautious because the uterine veins are very close to the artery. After the circumferential dissection of the artery, the temporary occlusion is conducted using 2-0 polyester suture. Posterior approach, lateral to the infundibulopelvic ligament For the ligation of the uterine artery posteriorly to the uterus and laterally to the pelvic infundibulum, the opening of the peritoneum of the broad ligament should start immediately below the round ligament, parallel to the external iliac vessels towards the base of the pelvic infundibulum. The avascular space is dissected by blunt dissection identifying the following landmarks: • Lateral: external iliac vessels; • Medial: pelvic infundibulum and the ureter attached to the peritoneum. The external iliac artery is dissected cranially in order to find the bifurcation of the common iliac artery and the internal iliac artery. The first medial branch of the anterior division of the internal iliac is normally the uterine artery. After dissection of the uterine artery it may be ligated according to the same technique described above. Conclusion Laparoscopic Uterine Artery legation may be performed during laparoscopic myomectomy to reduce intraoperative blood loss. According to surgical scenario, the surgeon may choose among one of the above-mentioned techniques to perform it.

1: Anatomic and vascular considerations in laparoscopic uterine artery ligation during hysterectomy

1: Anatomic and vascular considerations in laparoscopic uterine artery ligation during hysterectomy

Lateral Approach to Laparoscopic Uterine Artery Ligation Previous to Laparoscopic Hysterectomy: The Anatomy of the Bermuda Trianglë

Lateral Approach to Laparoscopic Uterine Artery Ligation Previous to Laparoscopic Hysterectomy: The Anatomy of the Bermuda Trianglë

Hysteroscopic resection of retained products of conception after temporal laparoscopic uterine artery ligation

Abstract Objective To describe hysteroscopic resection of retained products of conception (RPOC) after temporal laparoscopic uterine artery ligation for prevention of massive bleeding. Materials and methods This retrospective study was based in a community medical care hospital. Eight patients with RPOC underwent hysteroscopic resection of RPOC. Before the procedure, we performed temporal laparoscopic uterine artery ligation for prevention of massive bleeding. Results Patients' clinical backgrounds, intervals between the abortion or delivery and the operation, serum human chorionic gonadotropin (hCG) level at diagnosis, surgical times, and blood loss levels during surgery were recorded. The mean patient age was 28.2 ± 4.7 years. The mean interval between the abortions or deliveries and the surgeries was 43.2 ± 20.2 days. Three patients underwent spontaneous abortions, three patients underwent artificial abortions, and two patients had vaginal deliveries. The mean serum hCG level at the initial diagnosis was 168.7 ± 310 IU/L. Rich blood flow in the RPOCs was revealed by two-dimensional Doppler ultrasound examinations. Temporal uterine artery ligation was performed in all patients. The mean surgical time was 123.6 ± 19.4 minutes, and the blood loss was minimal in all eight cases. Neither blood transfusion nor conversion to laparotomy was required. The histologic evaluation revealed trophoblastic cells in all cases. Conclusion Hysteroscopic resection of RPOC after temporal laparoscopic uterine artery ligation is an effective and safe procedure for controlling bleeding.

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy vs Laparoscopic Myomectomy in Treatment of Symptomatic Myoma

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy vs Laparoscopic Myomectomy in Treatment of Symptomatic Myoma

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy vs Laparoscopic Myomectomy in Treatment of Symptomatic Myoma

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy vs Laparoscopic Myomectomy in Treatment of Symptomatic Myoma

一時的に腹腔鏡下子宮動脈結紮術を行い、子宮鏡下に胎嚢除去術を施行した帝王切開瘢痕部妊娠の1例

一時的に腹腔鏡下子宮動脈結紮術を行い、子宮鏡下に胎嚢除去術を施行した帝王切開瘢痕部妊娠の1例

Strangulated small intestinal hernia through infraumbilical port site following laparoscopic myomectomy

A 38-year-old parous woman with a body mass index of 22.6 kg/m and a history of progressive menorrhagia and urinary frequency underwent laparoscopic myomectomy and uterine artery ligation for uterine fundal intramural leiomyoma measuring 10 cm 8 cm [1,2]. The Veress needle technique was used to create the pneumoperitoneum and then a 12-mm infraumbilical vertical skin incision for a main trocar and sleeve was made to allow placement of the 10-mm laparoscope. We used an electromechanical morcellator to retrieve the specimen through a 15-mm lateral port across the lower abdomen. The intraoperative course was smooth and the infraumbilical fascia and subcutaneous layer were separately closed by 3-0 Vicryl suture (Polyglactin 910; Ethicon, Sommerville, NJ, USA). Fifteen hours after the procedure, in the early morning of the 1st day postoperatively, she presented with symptoms of painful abdomen and nausea. After removing the covering gauze, an incarcerated loop of small bowel with gangrenewas noted in the umbilical trocar site (Fig. 1A and B). Hence, an emergency reoperation was done by a general surgeon for the evaluation of unreducible intestinal gangrenous change. The fascial sutures were found to be almost loosening. An 8-cm segment of the necrotic jejunum (Fig. 2) had to be resected, with reconstruction by end-to-end anastomosis, which was located 90 cm proximal to the ileocecal valve through laparotomy. The patient recovered uneventfully and was discharged 8 days after her second operation, tolerating a regular diet. This case illustrates a rare complication of laparoscopic port insertion. The timing of the occurrence of herniation of

Comparison of Laparoscopic Myomectomy Using in Situ Morcellation With and Without Uterine Artery Ligation for Treatment of Symptomatic Myomas

Study ObjectiveTo evaluate the efficacy of laparoscopic uterine artery ligation (LUAL) before in situ morcellation (ISM) compared with ISM alone. DesignProspective study (Canadian Task Force classification II-1). SettingUniversity-affiliated hospital. PatientsOne hundred forty-four women with symptomatic uterine myomas, of whom 45 underwent LUAL and ISM and 99 underwent ISM only, from August 2007 through August 2009. InterventionsLigation or no ligation of the uterine arteries before ISM. Measurements and Main ResultsIn the LUAL+ISM group compared with the ISM group, mean (SD) operative time was significantly longer (107 [34] minutes vs 93 [35] minutes; p = .03), and there was less intraoperative blood loss (84 [53] mL vs 137 [166] mL; p < .001). Eight patients in the ISM group (8.1%) required a blood transfusion, including 4 (4.0%) with excessive intraoperative bleeding and 4 (4.0%) with postoperative hematomas. Although myomas in the LUAL+ISM group weighed more (p < .001), none of the patients in that group had excessive intraoperative bleeding, postoperative hematomas, or required blood transfusion (p = .046). At 2 years of follow-up, in the LUAL+ISM group compared with the ISM group, the myoma recurrence rate was 7% vs 24%, and symptom improvement was reported by 98% of patients vs 86% (statistically significant). ConclusionLaparoscopic myomectomy using an ISM technique with or without simultaneous LUAL may be used in the management of symptomatic uterine myomas; however, LUAL+ISM may result in a better surgical outcome.

Laparoscopic Ipsilateral Uterine Artery Ligation: A Right Cornual Ectopic Pregnancy Associated with Findings of Hypervascularity

Laparoscopic Ipsilateral Uterine Artery Ligation: A Right Cornual Ectopic Pregnancy Associated with Findings of Hypervascularity

Simultaneous laparoscopic uterine artery ligation and laparoscopic myomectomy for symptomatic uterine myomas with and without in situ morcellation

To determine the optimal surgical approach for laparoscopic uterine artery ligation (LUAL) combined with myomectomy in the management of women with symptomatic uterine fibroids. This is a prospective study. One hundred and six women with symptomatic uterine myomas underwent LUAL + laparoscopic morcellation after enucleation (enucleation group) (n = 51) or LUAL + laparoscopic in situ morcellation (ISM group) (n = 55). The outcome was measured by comparing surgical techniques, symptom control, recurrence and pregnancy during a 3-year follow-up in both groups. General characteristics of the patients were similar in both groups, except the myomas were larger in the ISM group. The operative time (mean ± SD) was significantly shorter in the ISM group than the enucleation group (107 ± 30 min versus 128 ± 49 min, P = 0.009). There were no differences in the therapeutic outcomes of the two groups at the 3-year follow-up, with low recurrence rates and good symptom control rates. Of the sexually active patients without contraception, the pregnancy and live birth rates were 87.5 and 100% in the ISM group and 66.7 and 83.3% in the enucleation group (all NS). The LUAL + myomectomy, either by enucleation or ISM, is acceptable in the management of symptomatic uterine fibroids. However, the LUAL + ISM technique might be more feasible, as it requires less operative time.

Influence of Laparoscopic Uterine Artery Ligation on Ovarian Function

Objective To evaluate the influence of laparoscopic uterine artery ligation on ovarian function. Methods In this retrospective study ,46 patients with laparoscopic myomectomy were selected and randomly divided into Ligation group and Non-Ligation group. The serum concentrations of follicular stimulating hormone (FSH), luteinizing hormone ( LH), estrogen ( E_2) were measured be-fore treatment and 1 ,3 ,6,12 months after treatment. Ovulating functions of ovary were monitored. All results were compared between two groups. Results All patients ovulated after 6 months. There were no significant differences between two groups in the levels of FSH, LH and E_2,.before and after treatment(P>0.05). Conclusions Laparoscopic uterine artery ligation do not affect ovarian function of pa-tients with uterine leiomyoma. Key words: Uterine Neoplasms; Ovarian function Tests

A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

BackgroundLaparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus.Methods and designPatients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation.DiscussionAmong treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with symptomatic relief. The current study fully recruited in June 2008 and the results will be available in June 2009. If there is no difference of postoperative QOL between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids, the comparison of quality of life between laparoscopic uterine artery ligation and uterine artery embolization will be also needed as a surgical treatment for preserving uterus.Trial registrationCurrent Controlled Trials ISRCTN76790866

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy Versus Laparoscopic Myomectomy in Treatment of Symptomatic Myoma

Study Objective: To evaluate the therapeutic effects of uterine artery ligation prior to laparoscopic myomectomy for the treatment of the symptomatic myomas and on decreasing operative morbidities compared to myomectomy alone.

Treatment of cervical pregnancy with laparoscopy-assisted uterine artery blockade followed by hysteroscopic endocervical resection: report of two cases

OBJECTIVE: To describe a successful conservative management based on laparoscopic bilateral uterine blockade and hysteroscopic endocervical resection of two nuliparous women with cervical pregnancy.DESIGN: Case study.MATERIALS AND METHODS: A 38-year-old primigravida and a 40-year-old nuliparous patient (with two previous spontaneous miscarriages) presented to the Emergency Room, both with history of lower abdominal discomfort and mild vaginal bleeding. They were diagnosed as 8 and 11 weeks pregnant, respectively, based on the date of their last menstruation. Transvaginal ultrasound depicted a well-formed gestational sac within the endocervical canal, containing a 13 mm live fetal pole and an inactive 15 mm fetal pole, respectively. A single systemic dose of metotrexate was administered at 50-mg/m2 body surface in both cases. Due to repeated high β-hCG serum levels, we performed a combination of laparoscopy and hysteroscopy: laparoscopy assisted uterine artery ligation to block blood perfusion to the uterus and cervix followed by hysteroscopic local endocervical resection of the ectopic pregnancy. In the first patient there was intraoperative heavy bleeding that ceased after a 30-ml Foley catheter balloon was placed and inflated in the cervical canal; it was removed after 48 hours.RESULTS: The first patient was discharged six days after the surgical procedure and the second one was discharged two days after the intervention, both without bleeding and with decreasing β-hCG serum levels. Four weeks later menstruation began.CONCLUSIONS: Combined laparoscopic uterine artery ligation and hysteroscopic resection could be a promising alternative in the conservative management of cervical pregnancy. A complementary balloon tamponade could be necessary in cases of heavy bleeding. OBJECTIVE: To describe a successful conservative management based on laparoscopic bilateral uterine blockade and hysteroscopic endocervical resection of two nuliparous women with cervical pregnancy. DESIGN: Case study. MATERIALS AND METHODS: A 38-year-old primigravida and a 40-year-old nuliparous patient (with two previous spontaneous miscarriages) presented to the Emergency Room, both with history of lower abdominal discomfort and mild vaginal bleeding. They were diagnosed as 8 and 11 weeks pregnant, respectively, based on the date of their last menstruation. Transvaginal ultrasound depicted a well-formed gestational sac within the endocervical canal, containing a 13 mm live fetal pole and an inactive 15 mm fetal pole, respectively. A single systemic dose of metotrexate was administered at 50-mg/m2 body surface in both cases. Due to repeated high β-hCG serum levels, we performed a combination of laparoscopy and hysteroscopy: laparoscopy assisted uterine artery ligation to block blood perfusion to the uterus and cervix followed by hysteroscopic local endocervical resection of the ectopic pregnancy. In the first patient there was intraoperative heavy bleeding that ceased after a 30-ml Foley catheter balloon was placed and inflated in the cervical canal; it was removed after 48 hours. RESULTS: The first patient was discharged six days after the surgical procedure and the second one was discharged two days after the intervention, both without bleeding and with decreasing β-hCG serum levels. Four weeks later menstruation began. CONCLUSIONS: Combined laparoscopic uterine artery ligation and hysteroscopic resection could be a promising alternative in the conservative management of cervical pregnancy. A complementary balloon tamponade could be necessary in cases of heavy bleeding.

A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma

To evaluate the efficacy of uterine artery ligation before laparoscopic myomectomy compared with myomectomy alone. Prospective controlled, clinical trial. Private and Shiraz University-affiliated hospitals. Of 152 women with symptomatic uterine myomas necessitating surgical intervention who wished to retain their uteri, 65 underwent laparoscopic uterine artery ligation and myomectomy (experimental group) and 87 received laparoscopic myomectomy only (control group). Ligation of the uterine arteries before laparoscopic myomectomy. Operating time, blood loss, blood transfusion, febrile morbidity, symptoms improvement, recurrence rate, and pregnancy rate. The average operating time and blood loss were 112 +/- 18 minutes and 173 +/- 91 mL for the experimental group and 95 +/- 14 minutes and 402 +/- 131 mL for the control group, respectively (statistically significant). A total of 15 (17.2%) of the control group patients required a blood transfusion, but none of the experimental group patients required one. Febrile morbidity occurred in 18.5% of the experimental group and 20.7% of the control group. In the experimental group, the recurrence of myoma was 6.2%, and 98.1% of the patients reported symptoms improvement; however, in the control group, these figures were 20.75% and 83.1%, respectively (statistically significant). The pregnancy rates were not statistically significantly different in the experimental group (35%) and the control group (35.7%). This study demonstrated the superiority of laparoscopic uterine artery ligation combined with myomectomy in treatment of symptomatic myomas.

Color Doppler evaluation of blood flow changes in leiomyomas after uterine artery ligation

Objective: To detect possible changes in main blood vessels within leiomyomas after uterine artery ligation using color Doppler sonography. Method: Blood flow in main leiomyoma blood vessels was measured before and after the procedure in 14 women who also had abnormal uterine bleeding, pelvic pain or pressure, and/or anemia. Results: Of the 14 patients, 13 reported complete disappearance of preoperative pain or pressure and 1 reported significant relief. Within 1 week to 4 months after uterine artery ligation, major blood flow within leiomyomas had significantly decreased in all patients. Eight months after the procedure, 1 of the women became pregnant. Conclusion: Laparoscopic uterine artery ligation via a lateral retroperitoneal technique is a safe and effective treatment for leiomyomas. Color Doppler sonography verified the ability of the procedure to diminish blood flow within leiomyomas in all patients.

Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma.

In treating women with leiomyoma and who wish to preserve their uterus, laparoscopic uterine artery ligation or uterine artery embolization should be considered as possible options. This study was performed to evaluate the efficacy of laparoscopic uterine artery ligation and uterine artery embolization in treating uterine myoma. The treatment outcomes of 23 patients who underwent uterine artery embolization and 17 laparoscopic uterine artery ligation were evaluated. The uterine volume reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed. On the other hand, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and slightly more reduced 6 months later. The average reduction in the case of laparoscopic uterine artery ligation was about 58.5%. After laparoscopic uterine artery ligation, 20% of the patients complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from a biopsy taken after each procedure. The results suggested that laparoscopic uterine artery ligation results mainly in physiologic cell death, that is apoptosis, whereas, the corresponding result is cell necrosis for uterine artery embolization. Uterine artery embolization and laparoscopic uterine artery ligation are both effective in relieving the symptoms caused by uterine myoma, and therefore both procedures can be used in place of hysterectomy or myomectomy.